Existing Non-cardiac Comorbidities Negatively Impact Quality of Life Gains After Left Ventricular Assist Device Implant

Patel, Dhrusti; Kelkar, Anita A.

Introduction The Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) collects quality of life data via Kansas City Cardiomyopathy Questionnaire (KCCQ-12) and Visual Analog Score (VAS). These data are collected pre- and post-LVAD implantation. Though previous studies have shown that overall health-related quality of life (HRQoL) improves at one year after implantation, specific factors that predict a higher quality of life have not been identified. Hypothesis Self-perceived quality of life after LVAD implant is influenced by demographics and preexisting comorbidities. Methods We identified 118 patients in the INTERMACS database who received a LVAD at our institution. Of these, 26 patients completed the KCCQ-12 questionnaire and 32 patients completed VAS at 1-year follow up. An exploratory data analysis was conducted using descriptive statistics, correlation tests, and non-parametric comparison tests such as Wilcoxon rank-sum to identify important trends and predictors for changes in HRQoL. Multiple variables (patient characteristics, clinical data) were tested independently against the KCCQ-12 and VAS scores at one year and with the absolute change in these scores over a one-year period. Due to low sample size, we were not able to perform a multivariate model. Results New York Heart Association Class IV symptoms at baseline (p=0.01) were predictive of large gains in VAS scores at one year. Frailty, although not reaching significance, may be associated with smaller magnitudes of improvement in KCCQ at one year (p=0.067). The presence of peripheral vascular disease at pre-implant predicts a lower VAS score at one year (p=0.03). Demographic factors such as age, sex, and marital status at implant did not predict higher post implant quality of life by either VAS or KCCQ. Conclusion Existing non-cardiac comorbidities should be taken into consideration when assessing the health related quality of life benefit of LVAD implantation.